insight into their cognitive appraisals.35 Assign Homework (28)The client was assigned homework exercises in which they do behavioral experiments to test biased versus alternative predictions.The client was assigned “Journal and Replace Self-Defeating Thoughts” in the Adult Psychotherapy Homework Planner (Jongsma & Bruce).The client was assisted in reviewing their insight regarding biased versus alternative predictions and successes were reinforced.The client was provided with corrective feedback toward improvement of understanding of biased or alternative predictions.
36 Teach Coping and Relapse Prevention Skills (36)The client was taught coping and relapse prevention skills via cognitive-behavioral techniques.The client was taught about delaying impulsive actions, structuring and scheduling daily activities, keeping a regular sleep routine, avoiding unrealistic goals striving, and using relaxation procedures.The client was taught about identifying and avoiding episode triggers.The client was assigned “Keeping a Daily Rhythm” in the Adult Psychotherapy Homework Planner (Jongsma & Bruce).The client was reinforced for understanding of taught skills.The client did not understand the provided skills and additional information was provided.
37 Conduct Family-Focused Treatment (37)The client and significant others were included in the treatment model.Family-focused treatment was used with the client and significant others as indicated in Bipolar Disorder: A Family-Focused Treatment Approach (Miklowitz & Goldstein).As family members were not available to participate in therapy, the family-focused treatment model was adapted to individual therapy.
38 Assess Family Communication (38)Objective instruments were used to assess the family communication.The level of expressed emotions within the family was specifically assessed.The family was educated about the role of aversive communication (e.g., highly expressed emotion), how it increases risk of relapse, and how change in communication style can reduce that risk.The family displayed a clear understanding of the effects of aversive communication and this was reinforced.The family was provided with feedback about their style of communication.The family has not been involved in the assessment of communication style, and the focus of treatment was diverted to this resistance.
39 Teach Communication Skills (39)Behavioral techniques were used to teach assertive communication skills.Assertive communication skills, such as offering positive feedback, active listening, making positive requests for behavioral change, and giving negative feedback in an honest, respectful manner, were taught to the client and family.Behavioral techniques were used to teach the family healthy communication skills.Education, modeling, role-playing, corrective feedback, and positive reinforcement were used to teach communication skills.The family was taught the HARD acronym: honest, appropriate, respectful, and direct.
40 Address Problem-Solving (40)The client was asked to identify conflicts that can be addressed through using problem-solving techniques.The family members were asked to give input about conflicts that could be addressed using problem-solving techniques.The client and family arrived at a list of conflicts that could be addressed using problem-solving techniques.
41 Teach Problem-Solving Skills (41)Cognitive behavioral techniques, such as education, modeling, role-playing, corrective feedback, and positive reinforcement, were used to teach the client and family problem-solving skills.Specific problem-solving skills were taught to the family, including defining the problem constructively and specifically, brainstorming options, evaluating options, choosing options, implementing a plan, evaluating the results, and reevaluating the plan.The client was assigned “Applying Problem-Solving to Interpersonal Conflict” in the Adult Psychotherapy Homework Planner (Jongsma & Bruce).Family members were asked to use the problem-solving skills in specific situations.The family was reinforced for positive use of problem-solving skills.The family was redirected for failure to properly use problem-solving skills.
42 Assign Problem-Solving Homework (42)The client and family were assigned to use newly learned problem-solving skills and record their use.The client and family were assigned “Plan Before Acting” in the Adult Psychotherapy Homework Planner (Jongsma & Bruce).The client and family were assigned “Problem Solving: An Alternative to Impulsive Action” in the Adult Psychotherapy Homework Planner (Jongsma & Bruce).The results of the family members’ use of problem-solving skills were reviewed within the session.The family members’ appropriate use of problem-solving skills was reinforced.The family members’ obstacles were resolved toward sustained, effective use.
43 Develop Relapse Drill (43)The client and family were assisted in drawing up a “relapse drill,” detailing roles and responsibilities.Family members were asked to take responsibility for specific roles (e.g., who will call a meeting of the family to address potential relapse; who will call the physician, schedule a serum level, or contact emergency services, if needed).Obstacles to providing family support to the client's potential relapse were reviewed and resolved.The family was asked to make a commitment to adherence to the plan.The family was reinforced for their commitment to adherence to the plan.The family has not developed a clear commitment to the relapse prevention plan and was redirected in this area.
44 Conduct Interpersonal and Social Rhythm Therapy (44)An assessment was conducted of the client's daily activities using an interview and the social rhythm metric.Information from the interview and social rhythm metric helped to conduct interpersonal and social rhythm therapy.
45 Establish Routine Daily Activities (45)The client was provided with the rationale for an optimal social rhythm.The client was assisted in establishing a more routine pattern of daily activities.The client was assisted in identifying a routine pattern of sleeping, eating, solitary and social activities, and exercise.A form was developed to help review and schedule activities.An emphasis was placed on creating a predictable rhythm for each day.
46 Teach About Sleep Hygiene Importance (46)The client was taught about the importance of good sleep hygiene.The client was assigned the “Sleep Pattern Record” from the Adult Psychotherapy Homework Planner (Jongsma & Bruce).The client's sleep pattern was routinely assessed.Interventions for the client's sleep pattern were provided, as they have been noted to have a dysfunctional sleep pattern.
47 Engage in Behavioral Activation (47)The client was engaged in “behavioral activation” by collaboratively identifying and scheduling activities that have a high likelihood for pleasure and mastery.The client was directed to complete tasks from the “Identify and Schedule Pleasant Activities” assignment from the Adult Psychotherapy Homework Planner (Jongsma & Bruce).Rehearsal, role-playing, role reversal, and other techniques were used to engage the client in behavioral activation.The client was reinforced for successes in scheduling activities that have a high likelihood for pleasure and mastery.The client has not engaged in pleasurable activities and was redirected to do so.
48 Conduct Interpersonal Portion of Therapy (48)The interpersonal component of the interpersonal and social rhythm therapy techniques was initiated.An assessment was completed of the client's current and past significant relationships, including themes related to grief, interpersonal role disputes, role transitions, and skill deficits.The client was supported in reviewing concerns related to interpersonal relationships.
49 Use Interpersonal Therapy Techniques to Resolve Interpersonal Problems (49)Interpersonal therapy techniques were used to explore and resolve issues surrounding grief, role disputes, and role transitions.The client was provided with direction and training in regard to skill deficits.Support and strategies for resolving identified interpersonal issues were provided.
50 Establish a Rescue Protocol (50)A rescue protocol was developed in order to identify and manage clinical deterioration.Specific factors that would trigger the rescue protocol were identified.Specific factors of the rescue protocol were developed, including medication use, sleep pattern restoration, daily routine, and conflict-free social support.The client and significant others were reinforced for their use of the rescue protocol.The client and significant others were redirected in regard to the use of the rescue protocol.
51 Schedule
